Behçet hastalığınınperforasyon Türkiye’denadirgörülen bir komplikasyonu: İntestinal

Although up to 50-60% of patients with Behcet’s disease present with intestinal involvement in Japan and Korea, it is very rare and accounts for only 1.4% of the cases in Turkey. The frequency of intestinal perforation which is an important complication of the disease is yet unknown. Here we present a 33 year-old man who presented to our hospital with a high fever, nausea, vomiting, abdominal pain and massive rectal bleeding following a recent hemorrhoidectomy operation and underwent a right hemicolectomy upon diagnosis of caecum perforation. His clinical history revealed a 12-year history of Beh;ccedil;et’s disease which was not properly treated and followed-up despite recurring mucocutaneous lesions. Superficial and deep penetrating ulcers were noted in the resection specimen of the case, along with venule predominant small vessel vasculitis, characterized by neutrophilic phlebitis and lymphocytic venulitis in particular. Intestinal Beh;ccedil;et’s disease, is an serious entity, for which the differential diagnosis can be very difficult from inflammatory bowel disease such as Crohn’s disease. It can also cause important morbidity with unpredictable intestinal perforations. The case was presented to increase awareness of the issue.Behçet Hastalığı’nın intestinal tutulumu, Japonya ve Kore’de olguların %50-60’ında görülmekle birlikte Türkiye’deki sıklığı %1,4’tür. Hastalığın önemli bir komplikasyonu olan intestinal perforasyonun sıklığı ise bilinmemektedir. Burada hemoroid operasyonu sonrası karın ağrısı, yüksek ateş, bulantı, kusma ve abondan rektal kanama yakınmasıyla başvurduğu merkezimizde çekum perforasyonu tanısıyla opere edilen 33 yaşında bir erkek hasta sunulmaktadır. Olgunun 12 yıl önce Behçet hastalığı tanısı aldığı ancak nüks eden mukokutanöz lezyonlarına rağmen düzenli bir tedavi görmediği öğrenilmiştir. Sağ hemikolektomi materyalinde yüzeyel ve derinleşen ülserler yanısıra özellikle küçük damarlarda lenfositik venülit ve nötrofilik flebit ile karakterli venül ağırlıklı vaskülit bulguları izlenmiştir. İntestinal Behçet hastalığı, Crohn hastalığı başta olmak üzere inflamatuar bağırsak hastalıklarından ayırımı güç bir antite olup, zamanı öngörülemeyen perforasyon riski nedeniyle de önemli bir morbidite kaynağıdır. Olgu bu konudaki farkındalığın artırılması amacıyla sunulmuştur

Acute Toxic Leukoencephalopathy: Etiologies, Imaging Findings, and Outcomes in 101 Patients

Prior studies regarding acute toxic leukoencephalopathy (ATL) are either small, or preliminary. Our aim was to evaluate etiologies of and differences in imaging severity and outcomes among various etiologies of ATL. MRIs of patients with suspected ATL over 15 years were retrospectively reviewed; inclusion criteria were: MRI <3 weeks of presentation with both DWI and FLAIR. These were jointly graded by two neuroradiologists via a previously described score of severity. Clinical outcome was evaluated via both modified Rankin (mRS) and ATL outcome (ATLOS) scores, each being correlated with the DWI and FLAIR scores. Etiologic subgroups of > 6 patients were statistically compared. Of 101 included patients, the 4 subgroups of > 6 were the following: chemotherapy ( = 35), opiates ( = 19), acute hepatic encephalopathy ( = 14), and immunosuppressants ( = 11). Other causes ( = 22 total) notably included carbon monoxide ( = 3) metronidazole ( = 2), and uremia ( = 1). The mean DWI/FLAIR severity scores were 2.6/2.3, 3.3/3.3, 2.1/2.1 and 2.0/2.5 for chemotherapeutics, opiates, AHE and immunosuppressants, respectively, with significant differences in both imaging severity and outcome ( = .003-.032) among subgroups, particularly immunosuppressant versus chemotherapy-related ATL and immunosuppressants versus opiates ( = .004-.032) related ATL. DWI and FLAIR severity weakly correlated with outcome (ρ = 0.289-.349, < .005) but correlated stronger in the chemotherapy (ρ = 0.460-.586, < .010) and opiate (ρ =.472-.608, < .05) subgroups, which had the worst outcomes. ATL clinically resolved in 36%, with severe outcomes in 23% (coma or death, 9/16 deaths from fludarabine). Notable laboratory results were elevated CSF myelin basic protein levels in 8/9 patients and serum blood urea nitrogen levels in 24/91. Clinical outcomes of ATL vary on the basis of etiology, being worse in chemotherapeutic- and opiate-related ATL. Uremia may be a predisposing or exacerbating factor